The Critical Role of Community Health Centers

Ensuring access to health care, not just health insurance

In the debate over federal health care reform—as
well as the future of BadgerCare—most have focused on the expansion of access
to affordable health insurance.

But what good is insurance if patients can’t see a
doctor?

Enter the federally qualified community health
centers, which are a critical component of health care in Milwaukee and around the country.

They exist in high-poverty, high-need areas—sections
of the community that the private health care systems have abandoned—and treat
everyone who comes through their doors, regardless of their insurance or
income.

Community health centers are not allowed to turn
away anyone who seeks medical care, making them the safety net in the health
care system.

They also take the pressure off of local and very
expensive emergency rooms, where uninsured individuals or those without a
primary care physician end up when they’re facing a health crisis.

These health care centers are so important that
Vermont Sen. Bernie Sanders included funding for them in the 2009 stimulus
package, and about $11 billion is earmarked for them in the health care reform
package currently being implemented.

“The appropriations that are slated for community
health centers is a win for all,” said Milwaukee Health Commissioner Bevan
Baker. “It will only make a good system better if we can use these
appropriations and grow these services.”

Stimulus funds have allowed Milwaukee’s community health centers to
expand their facilities, hire more doctors and staff, and switch from paper to
electronic health records.

But there’s still much more that Milwaukee’s community health centers want to
do—establish more clinics, hire more staff members, and add more services such
as dentistry and behavior health to their practices.

That’s critical because demand for health care
services will grow in the coming years as more people have health insurance,
whether it’s through a Medicaid program like BadgerCare or through one’s
employer or a state-based health insurance exchange.

But with that growth in demand, will private health
systems take on these new patients, especially those who are covered by
Medicaid programs?

That’s to be determined, said Tom Petri, policy and
communications director for Wisconsin Primary Health Care Association (WPHCA).
And that’s where community health centers fit into the larger health care
puzzle, Petri said.

“What’s unsure and not mandated in health care
reform is that health care providers see everyone who has an appointment,”
Petri said. “Our overriding concern is, ‘Where are these people going to go?’
We want to be the provider of choice. We already are for so many people.”

Serving the Community

Wisconsin
has 17 nonprofit community health centers with about 75 service locations that
served 244,000 patients in 2009. Each center is tailored to the needs in its
neighborhood and the majority of each organization’s board of directors is made
up of its patients. Revenues come from an annual federal grant, patient
payments and private donations.

Milwaukee
County is home to four
organizations that provide primary medical care to almost 80,000 residents with
a lack of access to physicians. While anyone can receive care at a community
health clinic, patients are typically low-wage earners.

These two factors—poverty and a lack of primary care
physicians—go hand in hand, according to a study by the Milwaukee Health Care
Partnership. The partnership found that the ZIP codes with the highest levels
of poverty have the fewest number of physicians. These areas, which run through
the heart of the county from north to south, account for 45% of the county but
only 27% of the primary care physicians in practice.

That gap in access means that residents are more
likely to go to an emergency room for their general health care needs—an
unsustainable use of scarce resources.

However, the county’s four community health centers
are filling the need for comprehensive health services in low-income areas:

The 16th Street
Community Health Center was established in 1971 in a storefront and now has two
full-service sites on the city’s near south side. The center has also won
federal funds to establish a satellite site in Waukesha, which is scheduled to open next
year. In 2009, more than 27,000 individuals—primarily young Hispanic residents
and their children—made 139,000 appointments at one of its clinics.

On the
near north and northwest sides, Milwaukee Health Services Inc. (MHSI) operates
two full clinics—a soon-to-be-expanded MLK Heritage Health Center on North
Martin Luther King Drive and the Isaac Coggs Heritage Health Center on West
Silver Spring Drive—as well as a convenient care clinic in Midtown. Last year,
more than 30,000 primarily African-American patients made 115,000 visits to one
of MHSI’s clinics.

The
Westside Healthcare Association (WHA) operates the Lisbon
Avenue Health
Center and the Hillside Family
Health Center
on North Seventh Street.
An estimated 6,600 patients, primarily African American, made about 20,000
visits to a WHA clinic last year.

Health
Care for the Homeless operates five sites and has links to 23 facilities around
town to provide health and dental care for about 11,000 of the area’s homeless
individuals.

Where would these patients go without the services
of the community health centers?

“That would have a large impact on Milwaukee,” said Tito Izard, M.D., interim
director of MHSI. “It would totally overwhelm the health systems which are
already struggling to maintain hospitals in cities.”

Reducing Costs Systemwide

The advantages of community health centers are many.
They reflect the needs of their patients and provide the proper level of care
for non-emergency health issues. They provide a “health home” with comprehensive
services for patients, whether it’s addressing an earache or virus, learning
about living with diabetes, being screened for cervical cancer or getting
support for a mental health issue.

This focus on primary, preventative care makes
community health centers highly cost-effective because their services reduce
the number of emergency, hospital and specialty care visits, saving the health
care system an estimated $24 billion a year nationwide.

“People have looked at us and said there’s a
low-cost alternative to just building more hospitals,” Petri said.

Milwaukee’s
community health clinics have forged relationships with local hospitals,
relationships that have been strengthened by a Milwaukee Health Care
Partnership initiative to coordinate emergency department care.

Partners are utilizing an electronic health
information exchange to share and collect patient data. They’re also sending
emergency room visitors to community health centers when it’s appropriate, and
can schedule same-day or next-day appointments at the health center directly
from the emergency room.

That saves the hospital’s resources while helping
the patient find a permanent health home at the center.

“Health homes promote prevention as well as provide
integrative care, in contrast to the typical experience, which is very
fragmented, with a lack of continuity from provider to provider,” said Joy
Tapper, executive director of the Milwaukee Health Care Partnership.

Dr. Izard of MHSI said that community health centers
will see any patient, regardless of insurance, which allows patients to receive
continuous care throughout the years—even when they’ve lost their
employer-provided insurance.

“Because of the recession, many people’s
relationships with their health care providers have been broken, but ours
haven’t,” Izard said.

Expansion Plans in the Works

Like many community health centers throughout the
country, Milwaukee’s
centers are in the midst of expanding, whether it’s increasing the square
footage of their current clinics, building additional facilities, increasing
their hours or providing more services. All four received federal stimulus
funding, but only one center—the 16th
Street Community Health Center—won additional
funding to establish a satellite center, which it will open in Waukesha in 2011.

Yet more plans exist.

For example, the Westside Healthcare Association is
ready to expand its Lisbon Avenue
site. WHA received $161,000 in stimulus funds because of increased demand for
its services, which allowed it to hire another doctor and support staff at its Hillside clinic, as well as expand its operating hours at
both of its clinics. WHA also used $442,000 in stimulus funds to switch over to
electronic health records, a major upgrade from its paper-based system.

But WHA desperately needs a new clinic on Lisbon Avenue, said
Sarah Andritsch, WHA’s fund development and marketing manager. Its current
facility is about 8,000 square feet, 80 years old, and was never intended to be
a clinic. WHA drew up plans for a new, 54,000-square-foot facility that would
double its capacity for dental services and add behavioral health, physical
therapy, occupational therapy and radiology to its menu of services. The total
cost is about $15 million; WHA had submitted a proposal for an $11 million grant
from the stimulus funds for facility expansion.

“We’re ready to put the shovels in the ground,”
Andritsch said.

But WHA’s project wasn’t selected.

“We need our building one way or another,” Andritsch
said.

The Milwaukee Health Care Partnership is currently
studying the centers’ expansion plans and goals. While federal funding through
the health care reform bill is still up in the air, another source of funds
could come from private donors or the local health care systems, which already
contribute to the centers. WPHCA’s Petri said that in other states, hospitals
have given large donations for capital expansion to health centers because they
know that a high-functioning community health center will reduce a hospital’s
expenses in the long run.

“It’s an investment that’s very difficult to make,
but at the same time the health centers are not fly-by-night, here-one-day,
gone-the-next operations,” Petri said. “That’s maybe what’s holding the health
centers back from enormous growth. But without what the hospitals are doing, we
would have seen very little growth at all over the last couple of years.”

This is an article I like to see, that there are efforts to fill in the cracks for those who private healthcare does not want to serve. Note particularly the attempt to make it more efficient, through the use of electronic records. That's what stimulus money is meant to do, put good ideas over the top when the cost-benefit analyisis does not show a quick return on investment.

Someone once told me that unlike other parts of the country that had run some form of "County Hospital", Milwaukee was notably devoid of such a service. I suppose I could say that all of Wisconsin is devoid of these "County Hospital" facilities, but I never did the research. And don't tell me that this is why we first need torte reform (aka immunity from malpractice suits).

Still, there is one big hole in this system... Location! Where are these free clinics out on the white suburb areas, you can't say that there are no white suburb people who have no health insurance, who have too many bills to go the doctor in their own community. Every single one of those providers needs a damn ss# (it's for taxes only, not commerce), so they can run a credit check, see if they will even want to serve a walk in, see if they are good for the money.

Where is that free clinic in a white area so a person who totally refuses to spend time in a waiting room with non-whites can get help? See the problem - it's our own people!

Where are the services who do not require an out of work suburb person to totally liquidate all their pensions or 401k's before they can get help? I ran into that when I had a stretch of unemployment, walked into a place near MLK. My 7 months out of work, followed by 9 years of continuous work in one good job. Was my 9 years of paying taxes supposed to be "euthanized" because of that 7months of neediness?

THAT is the reason a realistic national healthcare is needed. It's not just a few impoverished zipcodes that need help.

Poll

A Milwaukee Fire and Police Commission panel upheld the firing of former Milwaukee Police officer Christopher Manney for violating department rules last April when he encountered Dontre Hamilton before fatally shooting him. Do you agree with the commission’s decision?